Provider Demographics
NPI:1821425463
Name:LONNIE T SCARBOROUGH MD LLC
Entity Type:Organization
Organization Name:LONNIE T SCARBOROUGH MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCARBOROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-352-9902
Mailing Address - Street 1:315 COMMERCIAL DR STE B3
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3631
Mailing Address - Country:US
Mailing Address - Phone:912-352-9902
Mailing Address - Fax:912-352-9960
Practice Address - Street 1:315 COMMERCIAL DR STE B3
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3631
Practice Address - Country:US
Practice Address - Phone:912-352-9902
Practice Address - Fax:912-352-9960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA22469174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty